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GW1--02905_Well Construction - GW1_20240510
..a.,ura,a.itstaaIlIKW4:dIlQDN 1.Well Contractor Information: For Internal Use Only: Chris King Welt C'ontmct Name 14.WATER ZONES FROM 2080-A ® oEscRtrrtoN • NC Wcll Contrartor Ccnification Number /0 f t• Mir v art Aqua Drill,Inc. is®CAST®multi-cased wells FROM ® DIAMETER si LINER ift a''u�hle). cEnenumi Company\sme �L' t.Well Construction Permit 4: 3 L) ®®M Sv2a 16.INNER CASING OR TUBING L contemn!dosed. llet all applicable nr//caastrua/on permits(!a we,County.State.Variance.etc) FRO® TO 100 3.Well Use(check well use): ® D44n1� THICK111111.. NESS Supply Well: ®®®- �i agricultural l—� �:VlunicipaUPubtic FROM T© DIAMETER SLOT SIZE lit Geothermal(Heating/Cooling Supply)' esidcndal Water Su I _= ailndustrialiConunercial pp y(single)d) Rcsidcntial Water Supply(shared) 1111111111111111111E1_-- !♦,Irrigation Non-Water Supply1&GROUT Well: PROM TO *Monitoring lEare EMPLACEMEtiT n1ETF10D&AMOUNT il Injection Well: ®Recovery � � �d >.,Aquifer Recharge, ®'�v i I Groundwater Remediatio„ :Kathie 0 Aquifer Storage and Recovery OSaiinlry Barrier 19 SAND/GRAB vC O a, :Aquifer Test Ftc® OStarmwater Drainage � En[P[.ArEatE:rr METHOD *Experimental Technology Subsidence Control it Experi m nt(Closed Loop) Tracer Geoffiermal(Close L000lingRettun) ! ,I,Other 20.DRILLING©h additional sheets ifn- (� •lain under(121 Remarks) FRO" DESCRIPTION cabs;h ) 4.Date Well(s)Completed:s�'aZ [ hardness. , •a�MO Well ID# �� 5a.Well Location: D• � �.� • �� ft. Glue � I3)ta azigY(Jl �C ® Faeiliry'( vu:r Na--- -'-----.-- " cltyID (ifappltea a ®®1111111111 7/j, Physical Addnss Coy and Zip ®© eaCi ®® MA UZ4 Couniy 21.REIt9At21{S Parcel ident-fie n No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decintar degrees: (if well field,one lifelong is sufficient) 22.CertiB Mien: N 6.Is(are)the wells ormaocot or s1 ,+ �Tcmporaty Signature ofCcetincd Well Caolta r oC 9( 7.Is this a YeA`y to an existing r By signing I/ru jornr.I homily rcrt(�•that the ntr//(s)uvs tve� �c ltlds is u t7nr/r,Jil/mu holm n %r rrlla®f era►n anr/,,0 repair fouler c2/ream*section won the bark el i/alafarm. with III NCdC 02C.0/00 or/SA NCAC O�C.0200 Well Construction l ,�Sian rtg( W, a accordance rplain the nature of the rare°file&reconl has bean prorlded to the'WI miner. R.For Gcoprobe/DP�or Closed-Loop Geothermal Wells having23.Site diagram or additional well details: S.For only t Tor is needed the same You may use the back of this construction. drilled Indicate TOTAL NL•MBER of wells construction details. You also tt provide additional well site may also attach additional details or well 9•'IoDtf wen depth below land P ifaeeessary. surface: S17BMlTIAL 4\STRUCT[ONS For inuh/plea.//slut all depthsld/ferent(erample-3t i2 i and'ral00ry (�) 24a• For AIL Wells: I0.Sta>;e wafer level below to of casing: Submit this form within 30 days of completion of well A / o construction to the following Ifwater t is water er levelve ing use-+ �L'� (ffi) Division of Water Resources,Information Processing Unit, 11.Borehole diameter: 1617 Mail Service Center,Raleigh,NC 27694-1617 (in.) 1 f 246.For Injection Wells: In addition to sending the form to the ad lie.anger,rotary-,cable,direct push.r.r a above,also submit one copy of this formwithin 30 days of comdress pletion in 24a construction to the following pletion of well IL Well construction method: FOR WATER SUPPLY WELLS ONLY: Division of-Water Resources,Undergrotmd Injection Control Program, 13a.I?era(;pm) 1636 Man Service Center,Raleigh,NC 27699-1636 Method attest:5 24c.For Water Su h•&In eetion Wells: In addition to sending the form to 13b.L''isiII:°ec(lau:ype; the address(es) above, also submit one co Amount:/ _ Z completion of well construction to the ebony health de of this form partment 30 days cof ounty where constructed. f y ePrIIent of the county North Carolina Department of Environmental Quality-Division of Water Resources Rpet,...,l o_en w....